Figure 174

Confirming a diagnosis of recurrent disease requires a renal biopsy. Features that favor recurrence include an active urine sediment with erythrocytes and erythrocyte casts, heavy proteinuria, and normal cyclosporine levels. Serologic testing for anti-glomerular basement membrane antibody is important in patients with Alport's or Goodpasture's syndrome, and blood film examination for patients with previous hemolytic uremic syndrome. Immuno-fluorescence and electron microscopic studies are rarely performed routinely on transplantation biopsies but can be vital in making a diagnosis of recurrent nephritis.